Loading...Loading...Regence medical policies are evidence-based and take into account the available scientific evidence published in peer-reviewed journals, as well as evidence-based clinical practice guidelines and specialty society statements. The process for Regence medical policy development is described in the Introduction to the Regence Medical Policy Manual.
In addition, Regence values the experience and opinions of practicing physicians and other health care providers. Your feedback on our policies is welcome and is an important part of our annual policy review process.
You may provide feedback to us on the following policies by:
- Responding to the email that directed you to this page. Please be sure to identify the policy you are providing comments on in your email response.
Contacting Medical Policy Staff. Please be sure to identify the policy in the policy name field, as well as your name, specialty and contact information. (Note: contact information only needs to be included if you do not regularly receive medical policy email notification from Regence.)
Anesthesiology - (2)
- Cranial Electrostimulation Therapy (CES), Durable Medical Equipment #83.06
- Manipulation Under Anesthesia, Medicine #130
Bariatric - (1)
Behavioral Health - (2)
- Drug Testing for Substance Use and Pain Management, Laboratory #68
- Investigational Gene Expression, Biomarker, and Multianalyte Testing, Laboratory #77
Cardiology - (8)
- Apolipoprotein E for Risk Assessment and Management of Cardiovascular Disease, Genetic Testing #05
- Genetic Testing for Familial Hypercholesterolemia, Genetic Testing #11
- Biomarkers for Cardiovascular Disease, Laboratory #78
- Myocardial Strain Imaging, Medicine #168
- Computed Tomography to Detect Coronary Artery Calcification, Radiology #06
- Ultrasonographic Measurement of Carotid Artery Intima-Media Thickness as an Assessment of Atherosclerosis, Radiology #37
- Ventricular Assist Devices and Total Artificial Hearts, Surgery #52
- Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation, Surgery #195
Chiropractic - (4)
- Cranial Electrostimulation Therapy (CES), Durable Medical Equipment #83.06
- Dry Needling, Medicine #39
- Manipulation Under Anesthesia, Medicine #130
- Thermography, Radiology #17
Dentistry - (1)
- Administrative Guidelines to Determine Dental vs Medical Services, Allied Health #35
Dermatology - (2)
- Investigational Gene Expression, Biomarker, and Multianalyte Testing, Laboratory #77
- Targeted Phototherapy for the Treatment of Psoriasis, Medicine #98
Endocrinology - (1)
ENT - (2)
- Vestibular Evoked Myogenic Potential Testing, Medicine #169
- Minimally Invasive Treatments of Nasal Valve Collapse or Obstruction, Surgery #209
Gastroenterology - (8)
- New and Emerging Medical Technologies and Procedures, Medicine #149
- Radiofrequency Ablation (RFA) of Tumors Other than Liver, Surgery #92
- Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (GERD), Surgery #110
- Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver, Surgery #132
- Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction, Surgery #134
- Orthognathic Surgery, Surgery #137
- Gastroesophageal Reflux Surgery, Surgery #186
- Transanal Hemorrhoidal Dearterialization, Surgery #219
General Surgery - (13)
- Negative Pressure Wound Therapy in the Outpatient Setting, Durable Medical Equipment #42
- Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer, Laboratory #60
- New and Emerging Medical Technologies and Procedures, Medicine #149
- Periurethral Transperineal Adjustable Balloon Continence Device, Medicine #176
- Radiofrequency Ablation (RFA) of Tumors Other than Liver, Surgery #92
- Percutaneous Angioplasty and Stenting of Veins, Surgery #109
- Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver, Surgery #132
- Gastroesophageal Reflux Surgery, Surgery #186
- Microwave Tumor Ablation, Surgery #189
- Ablation of Primary and Metastatic Liver Tumors, Surgery #204
- Minimally Invasive Treatments of Nasal Valve Collapse or Obstruction, Surgery #209
- Intraosseous Radiofrequency Ablation of the Basivertebral Nerve, Surgery #225
- Vertebral Body Tethering and Staplinges, Surgery #232
Genetics- (6)
- Apolipoprotein E for Risk Assessment and Management of Cardiovascular Disease, Genetic Testing #05
- KRAS, NRAS, and BRAF Variant Analysis and MicroRNA Expression Testing for Colorectal Cancer, Genetic Testing #13
- Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer, Genetic Testing #42
- Molecular Testing for Interstitial Lung Disease, Genetic Testing #55
- Targeted Genetic Testing for Selection of Therapy for Non-Small Cell Lung Cancer (NSCLC), Genetic Testing #56
- Genetic Testing for Methionine Metabolism Enzymes, including MTHFR, Genetic Testing #65
Heamtology Oncology - (12)
- Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer, Genetic Testing #42
- Molecular Testing for Interstitial Lung Disease, Genetic Testing #55
- Targeted Genetic Testing for Selection of Therapy for Non-Small Cell Lung Cancer (NSCLC), Genetic Testing #56
- Analysis of Proteomic and Metabolomic Patterns for Cancer Detection, Risk, Prognosis, or Treatment Selection, Laboratory #41
- Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer, Laboratory #60
- Laboratory and Genetic Testing for Use of Fluoropyrimidine (5-FU and Capecitabine) in Patients with Cancer, Laboratory #64
- Radiofrequency Ablation (RFA) of Tumors Other than Liver, Surgery #92
- Percutaneous Angioplasty and Stenting of Veins, Surgery #109
- Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver, Surgery #132
- Ablation of Primary and Metastatic Liver Tumors, Surgery #204
- Hematopoietic Cell Transplantation for Non-Hodgkin's Lymphomas, Transplant #45.23
- Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma, Transplant #45.35
Naturopath - (1)
- Genetic Testing for Methionine Metabolism Enzymes, including MTHFR, Genetic Testing #65
Nephrology - (1)
Neurology - (12)
- Galvanic Stimulation, Durable Medical Equipment #83.01
- H-wave Stimulation, Durable Medical Equipment #83.02
- Microcurrent Stimulation (MENS), Durable Medical Equipment #83.03
- Functional Neuromuscular Electrical Stimulation, Durable Medical Equipment #83.04
- Threshold Electrical Stimulation as a Treatment of Motor Disorders, Durable Medical Equipment #83.05
- Automated Point-of-Care Nerve Conduction Studies, Medicine #128
- Vestibular Evoked Myogenic Potential Testing, Medicine #169
- Laser Interstitial Thermal Therapy, Medicine #177
- Thermography, Radiology #17
- Percutaneous Angioplasty and Stenting of Veins, Surgery #109
- Pulsed Radiofrequency for Chronic Spinal Pain, Surgery #156
- Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation, Surgery #195
- Responsive Neurostimulation, Surgery #216
Neurosurgery - (9)
- Functional Neuromuscular Electrical Stimulation, Durable Medical Equipment #83.04
- Automated Point-of-Care Nerve Conduction Studies, Medicine #128
- Laser Interstitial Thermal Therapy, Medicine #177
- Thermography, Radiology #17
- Pulsed Radiofrequency for Chronic Spinal Pain, Surgery #156
- Interspinous Fixation (Fusion) Devices, Surgery #172
- Image-Guided Minimally Invasive Spinal Decompression (IG-MSD) for Spinal Stenosis, Surgery #176
- Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation, Surgery #195
- Intraosseous Radiofrequency Ablation of the Basivertebral Nerve, Surgery #225
Obstetrics and Gynecology - (9)
- Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer, Genetic Testing #42
- Placental Rapid Immunoassay for Detection of Fetal Membrane Rupture, Laboratory #57
- Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer, Laboratory #60
- Thermography, Radiology #17
- Cone Beam Computed Tomography of the Breast, Radiology #59
- Radiofrequency Ablation (RFA) of Tumors Other than Liver, Surgery #92
- Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction, Surgery #134
- Orthognathic Surgery, Surgery #137
- Subcutaneous Tibial Nerve Stimulation, Surgery #154
Oncology - (10)
- KRAS, NRAS, and BRAF Variant Analysis and MicroRNA Expression Testing for Colorectal Cancer, Genetic Testing #13
- Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer, Genetic Testing #42
- Laboratory and Genetic Testing for Use of Fluoropyrimidine (5-FU and Capecitabine) in Patients with Cancer, Laboratory #64
- Investigational Gene Expression, Biomarker, and Multianalyte Testing, Laboratory #77
- Cone Beam Computed Tomography of the Breast, Radiology #59
- Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver, Surgery #132
- Microwave Tumor Ablation, Surgery #189
- Ablation of Primary and Metastatic Liver Tumors, Surgery #204
- Hematopoietic Cell Transplantation for Non-Hodgkin's Lymphomas, Transplant #45.23
- Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma, Transplant #45.35
Ophthalmology - (1)
- New and Emerging Medical Technologies and Procedures, Medicine #149
Orthopedics - (11)
- Functional Neuromuscular Electrical Stimulation, Durable Medical Equipment #83.04
- General Medical Necessity Guidance for Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS), Durable Medical Equipment #88
- Manipulation Under Anesthesia, Medicine #130
- Thermography, Radiology #17
- Radiofrequency Ablation (RFA) of Tumors Other than Liver, Surgery #92
- Femoroacetabular Impingement Surgery, Surgery #160
- Interspinous Fixation (Fusion) Devices, Surgery #172
- Image-Guided Minimally Invasive Spinal Decompression (IG-MSD) for Spinal Stenosis, Surgery #176
- Intraosseous Radiofrequency Ablation of the Basivertebral Nerve, Surgery #225
- Shoulder Surgeries, Surgery #228
- Vertebral Body Tethering and Staplinges, Surgery #232
Pathology - (3)
- Analysis of Proteomic and Metabolomic Patterns for Cancer Detection, Risk, Prognosis, or Treatment Selection, Laboratory #41
- Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer, Laboratory #60
- Laboratory and Genetic Testing for Use of Fluoropyrimidine (5-FU and Capecitabine) in Patients with Cancer, Laboratory #64
Pediatric Surgery - (2)
- Negative Pressure Wound Therapy in the Outpatient Setting, Durable Medical Equipment #42
- Microwave Tumor Ablation, Surgery #189
Pediatrics - (3)
- Threshold Electrical Stimulation as a Treatment of Motor Disorders, Durable Medical Equipment #83.05
- New and Emerging Medical Technologies and Procedures, Medicine #149
- Responsive Neurostimulation, Surgery #216
Physical Medicine - (8)
- Galvanic Stimulation, Durable Medical Equipment #83.01
- H-wave Stimulation, Durable Medical Equipment #83.02
- Microcurrent Stimulation (MENS), Durable Medical Equipment #83.03
- Functional Neuromuscular Electrical Stimulation, Durable Medical Equipment #83.04
- Threshold Electrical Stimulation as a Treatment of Motor Disorders, Durable Medical Equipment #83.05
- Cranial Electrostimulation Therapy (CES), Durable Medical Equipment #83.06
- General Medical Necessity Guidance for Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS), Durable Medical Equipment #88
- Manipulation Under Anesthesia, Medicine #130
Primary Care - (26)
- Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Clinical Practice Guideline
- Administrative Guidelines to Determine Dental vs Medical Services, Allied Health #35
- Negative Pressure Wound Therapy in the Outpatient Setting, Durable Medical Equipment #42
- Galvanic Stimulation, Durable Medical Equipment #83.01
- H-wave Stimulation, Durable Medical Equipment #83.02
- Microcurrent Stimulation (MENS), Durable Medical Equipment #83.03
- Functional Neuromuscular Electrical Stimulation, Durable Medical Equipment #83.04
- Cranial Electrostimulation Therapy (CES), Durable Medical Equipment #83.06
- General Medical Necessity Guidance for Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS), Durable Medical Equipment #88
- Apolipoprotein E for Risk Assessment and Management of Cardiovascular Disease, Genetic Testing #05
- Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer, Genetic Testing #42
- Genetic Testing for Methionine Metabolism Enzymes, including MTHFR, Genetic Testing #65
- Placental Rapid Immunoassay for Detection of Fetal Membrane Rupture, Laboratory #57
- Drug Testing for Substance Use and Pain Management, Laboratory #68
- Biomarkers for Cardiovascular Disease, Laboratory #78
- Dry Needling, Medicine #39
- Targeted Phototherapy for the Treatment of Psoriasis, Medicine #98
- Automated Point-of-Care Nerve Conduction Studies, Medicine #128
- Manipulation Under Anesthesia, Medicine #130
- New and Emerging Medical Technologies and Procedures, Medicine #149
- Coverage of Treatments Provided in a Clinical Trial, Medicine #150
- Thermography, Radiology #17
- Ultrasonographic Measurement of Carotid Artery Intima-Media Thickness as an Assessment of Atherosclerosis, Radiology #37
- Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction, Surgery #134
- Orthognathic Surgery, Surgery #137
- Subcutaneous Tibial Nerve Stimulation, Surgery #154
- Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation, Surgery #195
Psychiatry - (2)
- Cranial Electrostimulation Therapy (CES), Durable Medical Equipment #83.06
- Drug Testing for Substance Use and Pain Management, Laboratory #68
Pulmonology - (2)
- Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Clinical Practice Guideline
- Gastroesophageal Reflux Surgery, Surgery #186
Radiation Oncology - (5)
- Cone Beam Computed Tomography of the Breast, Radiology #59
- Laser Interstitial Thermal Therapy, Medicine #177
- Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver, Surgery #132
- Microwave Tumor Ablation, Surgery #189
- Ablation of Primary and Metastatic Liver Tumors, Surgery #204
Radiology - (8)
- Computed Tomography to Detect Coronary Artery Calcification, Radiology #06
- Thermography, Radiology #17
- Ultrasonographic Measurement of Carotid Artery Intima-Media Thickness as an Assessment of Atherosclerosis, Radiology #37
- Percutaneous Angioplasty and Stenting of Veins, Surgery #109
- Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver, Surgery #132
- Pulsed Radiofrequency for Chronic Spinal Pain, Surgery #156
- Ablation of Primary and Metastatic Liver Tumors, Surgery #204
- Hematopoietic Cell Transplantation for Non-Hodgkin's Lymphomas, Transplant #45.23
Urology - (2)
- Laboratory and Genetic Testing for Use of Fluoropyrimidine (5-FU and Capecitabine) in Patients with Cancer, Laboratory #64
- Periurethral Transperineal Adjustable Balloon Continence Device, Medicine #176
- Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver, Surgery #132
- Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction, Surgery #134
- Orthognathic Surgery, Surgery #137
- Subcutaneous Tibial Nerve Stimulation, Surgery #154
- Ablation of Primary and Metastatic Liver Tumors, Surgery #204
- Benign Prostatic Hyperplasia Surgical Treatments, Surgery #210